Limitations of Clinical
Experience
The first principle is that you must not fool
yourself, and you are the easiest person to fool
Richard Feynman
The real purpose of the scientific method is
to make sure Nature hasn't misled you into
thinking you know something you actually
don't know.
Robert Pirsig
Zen and the Art of Motorcycle Maintenance
Why We Get Things Wrong
• Self-limiting Disease (most things get better without
us)
• Regression to the Mean (chronic diseases wax and
wane; people come to see us when things are at their
worst)
• Placebo (mostly by proxy)
• Confirmation Bias (we see what we expect and want
to see)
• Cognitive Dissonance (we don’t accept being wrong)
The Bad News
• Being smart, well-educated, experience, or wellintentioned doesn’t protect us much from common
errors
• The judgment of individuals, however respected or
numerous, is less reliable than the assessment of
objective scientific research
The Good News
As near as my husband and I can figure, your
book, Baby and Child Care, has become
the Modern Bible of American Parenthood
Baby and Child Care is the Bible in my
household. I do not know of any book which I
admire more
By 1973 Baby and Child Care had gone through 201 printings and sold
over 23 million copies; been translated into 29 languages; and was
world's best-selling title written by an American. For two decades it sold
about a million copies a year.
Every time the supply [of the book] runs out I get verbal and written
pleas not only from parents, and relatives and friends of prospective
parents, but from schools of social work, medical schools, teacher
training schools, etc., who are using the book as a text, from
obstetricians and pediatricians who give the book to each new patient,
and even from a state health dept which is recommending it routinely
Advice to Prevent SIDS
Babies Should Sleep on Their Stomachs
There are two disadvantages to a baby’s sleeping on his back. If
he vomits, he’s more likely to choke on the vomitus. Also, he
tends to keep his head turned toward the same side—usually the
center of the room. This may flatten that side of his head.
I think it is preferable to accustom a baby to sleeping on his
stomach from the start if he is willing.
Benjamin Spock, MD
SIDS Research
Advice to put infants to sleep on the front for nearly a half
century was contrary to evidence available from 1970 that this
was likely to be harmful. Systematic review of preventable risk
factors for SIDS from 1970 would have led to earlier
recognition of the risks of sleeping on the front and might have
prevented over 10,000 infant deaths in the UK and at least
50,000 in Europe, the USA, and Australasia.
Infant sleeping position and the sudden infant death syndrome: systematic review of
observational studies and historical review of recommendations from 1940 to 2002
Ruth Gilbert, Georgia Salanti, Melissa Harden, and Sarah See
SIDS Incidence and Sleeping Position Before and After
Public Education Campaign to Reduce Prone Sleeping